Respiratory Cloud Clinical Skills Library

Clinical knowledge review

Contraindications

Use these educational prompts with current orders, protocols, patient assessment, facility policy, and supervising-clinician direction.

Skill

Extubation

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Contraindications Conditions identified as reasons to avoid or defer the procedure pending authorized clinical review. View list Relative contraindications Factors requiring individualized risk-benefit assessment, added precautions, or a modified approach. View list

Contraindications

Review these conditions before proceeding and follow current orders, protocols, facility policy, and supervising-clinician direction.

  • Do not perform planned extubation when readiness criteria are not met, the patient cannot protect the airway, clinically important obstruction remains, or a safe reintubation plan is unavailable.

Relative contraindications

Use individualized risk-benefit assessment, added precautions, or a modified approach as authorized for the patient and setting.

  • High risk for laryngeal edema, difficult reintubation, weak cough, heavy secretions, or marginal gas exchange requires additional planning and surveillance.

Sources

Supporting sources include peer-reviewed research, evidence-based clinical practice guidelines, professional standards, and foundational respiratory care references, as applicable to the skill.

  1. Roberts KJ, Goodfellow LT, Battey-Muse CM, et al. AARC Clinical Practice Guideline: Spontaneous Breathing Trials for Liberation From Adult Mechanical Ventilation. Respir Care. 2024;69(7):891-901. doi:10.4187/respcare.11735. PMID:38443142.
  2. Law JA, Duggan LV, Asselin M, et al. Canadian Airway Focus Group updated consensus-based recommendations for management of the difficult airway: part 2. Planning and implementing safe management of the patient with an anticipated difficult airway. Can J Anaesth. 2021;68(9):1405-1436. doi:10.1007/s12630-021-02008-z. PMID:34105065.
  3. Kuriyama A, Jackson JL, Kamei J. Performance of the cuff leak test in adults in predicting post-extubation airway complications: a systematic review and meta-analysis. Crit Care. 2020;24(1):640. doi:10.1186/s13054-020-03358-8. PMID:33160405.